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Venting about medical treatment

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Venting about medical treatment

Old 10-13-19, 08:32 AM
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Venting about medical treatment

I just want to vent about medical practices for a minute.
I'm going on 59 years old, I have all these medical issues that many of you have. One of my knees has been in discomfort for a few years due to a couple of injuries several years ago. I I have golfer's elbow (I don't play golf) from swinging an axe a couple of months ago. I saw my PCP for that and he prescribed Celebrex (and referred me to Ortho which I go to on Oct 15th). But the Celebrex didn't seem to do much. And, I have a case of Morton's Neuroma (MN) that I've been dealing with for about 6-7 years I guess. I was seen once for the MN several years ago for temporary relief. But it's getting worse...it frequently gets painful on bike rides after about 25 miles, and sometimes wakes me up in the night. I finally decided to seek permanent relief. So I went back to the podiatrist this week (different one than last time). He gave me the initial shot in the foot, AND put me on a battery of steroids (methylprednisolone 4mg)...21 pills to be taken at precise intervals over six days. He explained that the steroid assists in neutralizing the nerve causing the MN pain. Today is day three. I've already got relief from the MN. BUT...my elbow is feeling better, and the discomfort in my knee seems to be waning too. So, I looked up to see what conditions methylprednisolone treats. The list is long, and includes all my ailments mentioned above. (https://www.webmd.com/drugs/2/drug-6...ist-conditions).

So my complaint is...WTF don't the doctors go directly to something like this steroid instead of making patients suffer? I guess when I go to Ortho on Tuesday for my elbow, I'll have to tell them "Oh, the foot doctor took care of that."

Dan
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Old 10-13-19, 09:53 AM
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Originally Posted by _ForceD_
I just want to vent about medical practices for a minute.
I'm going on 59 years old, I have all these medical issues that many of you have. One of my knees has been in discomfort for a few years due to a couple of injuries several years ago. I I have golfer's elbow (I don't play golf) from swinging an axe a couple of months ago. I saw my PCP for that and he prescribed Celebrex (and referred me to Ortho which I go to on Oct 15th). But the Celebrex didn't seem to do much. And, I have a case of Morton's Neuroma (MN) that I've been dealing with for about 6-7 years I guess. I was seen once for the MN several years ago for temporary relief. But it's getting worse...it frequently gets painful on bike rides after about 25 miles, and sometimes wakes me up in the night. I finally decided to seek permanent relief. So I went back to the podiatrist this week (different one than last time). He gave me the initial shot in the foot, AND put me on a battery of steroids (methylprednisolone 4mg)...21 pills to be taken at precise intervals over six days. He explained that the steroid assists in neutralizing the nerve causing the MN pain. Today is day three. I've already got relief from the MN. BUT...my elbow is feeling better, and the discomfort in my knee seems to be waning too. So, I looked up to see what conditions methylprednisolone treats. The list is long, and includes all my ailments mentioned above. (https://www.webmd.com/drugs/2/drug-6...ist-conditions).

So my complaint is...WTF don't the doctors go directly to something like this steroid instead of making patients suffer? I guess when I go to Ortho on Tuesday for my elbow, I'll have to tell them "Oh, the foot doctor took care of that."

Dan
Well, the issue is that steroids have serious side effects and are used by physicians pretty much as a last resort, though there are a few conditions for which it's the only known treatment. I've had one of those latter ailments and felt so good after starting treatment that I was joyous with my doc. He told me, "Yes, I could give that to a patient with bone cancer and they'd feel great." That steroid class is perhaps the most powerful anti-inflammatory known. Hence your good result. As an anti-inflammatory, it works really well while you're taking it. The question remains: Will your issues come right back a week or a month after stopping the steroid?

The neuroma can be treated surgically. The elbow should respond to specific strength training work - probably PT to start with, then continuing on your own. If your doc doesn't tell you this, try another doc.
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Old 10-13-19, 11:11 AM
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I had Golfer's Elbow a couple years ago from carrying some heavy chunks of log. It went away on it's own after several months. I wakeboard a lot, so that is probably what rehabed the elbow. Steroids compromise your immune system. So it's best to use them carefully.
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Old 10-13-19, 12:28 PM
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Originally Posted by _ForceD_
So my complaint is...WTF don't the doctors go directly to something like this steroid instead of making patients suffer?
Powerful steroids like methyprednisolone have many detrimental side effects, most of which appear with chronic use. They're not drugs to be prescribed lightly. They can suppress inflammatory reactions such as you've described, but also inhibit healing, exacerbate conditions like diabetes, cause muscle and bone loss, and for anything other than one-off dosage must be tapered carefully to avoid dangerous adrenal insufficiency.
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Old 10-13-19, 03:26 PM
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Be really careful with the prednisone. Back in June, I went on what turned into a 45 mile ride into headwinds both ways, with my lower right back already feeling a little tweaked. 3 miles from home my right quad cramped a bit but I made it home and felt good after. Woke up the next morning with back and leg in extreme pain that just got worse to where I went to the urgent care a week later. They diagnosed sciatica and gave me prednisone for 12 days with tapering down to zero after that time. I felt better within a couple of days but the prednisone made me feel not right (vague, I know) and after the taper ended, I really felt unwell for a couple of days. I'd be very reluctant to use it again for anything short of an extreme need.
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Old 10-13-19, 04:29 PM
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I have no intention of using this med, or any steroids, beyond what is prescribed by the doctor. But I'm halfway through this six-day perscription and all these other ailements are feeling so much better. I don't seem to be having any side affects. It's just that I wish relief was always as easy as that.

Dan
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Old 10-13-19, 06:29 PM
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Old 10-14-19, 12:07 AM
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Yup, coping with chronic pain is frustrating. More so nowadays with anti-opiate hysteria tainting the issue. Too many doctors and nurses assume complaints about pain are hidden ploys to get doped up. Most of us are just looking for a cure, not a temporary fix.

And they're cautious about prednisone, as other folks said. It has all kinds of potential side effects. Among other problems, in older men it tends to cause mood disorders -- basically, 'roid rage. Happened to my grandfather and a neighbor who took it for COPD. Both older men had bouts of being almost insufferable to family and friends.

My docs are cautious about prescribing prednisone because I have osteopenia. I've used it a few times over the decades for serious respiratory inflammations, but that's all. And they prefer to try it only once a year.

Ask about oral diclofenac, or the topical version. It's an NSAID but needs much lower doses than ibuprofen. I take two small pills a day for chronic inflammation.

Also for that foot pain try Ted's Pain Cream. Read the website. Yeah, I know, everyone with chronic pain has tried topical analgesics and they almost never work. But read this literature on this one. It can work very well when used as directed. There's evidence that resveratrol used topically can work better than oral resveratrol, and may work better for chronic pain than other common topicals -- wintergreen oil, capsaicin, arnica, many, many others.

The tricky part is, it tends to work best on old injuries that have technically "healed" but still cause lingering pain. It's not effective on recent injuries or those that haven't healed. It seems to target nerves that are stuck in pain mode long after the pain signals should have subsided.

In my case, after a shoulder injury last year (hit by a car in May 2018, broke and dislocated my shoulder, aggravated an old neck injury), Ted's didn't help at all last year. I still needed prescription pain relievers for months after the injury, and gradually discontinued hydrocodone tramadol and cyclobenzaprine on my own (I still have them, I just rarely use them). I substituted CBD, which can be effective for moderate chronic pain, and kratom for more serious pain.

But by 2019 the injury was technically healed, but still causing a lot of pain. Physical therapy helped a little. Chiropractors didn't help at all, and one made my neck pain worse. So I tried Ted's Pain Cream again starting this summer, along with a double head percussion massager. Used as directed -- three times a day for the first week or so, then once a day -- it relieved pain around my shoulder blade that had made sleeping difficult. There were spots about the size of dimes along the periphery of my shoulder blade that felt like jolts of electricity when touched. The combination of Ted's and the massager dialed it down to 3-4. There's a knotted up muscle or tendon along my neck and shoulder that has ached persistently for almost 15 years. It's down to about a 3-4, which is a significant improvement. That chronic pain used to be my main limiting factor in bike rides, usually limiting me to 20-40 miles. Now I can handle longer rides and a couple of weeks ago finished my first solo century in years. I still get some aches, especially when weather changes are accompanied by barometric pressure shifts. But it's much better.

Ted's will probably be useful only for areas just below the skin. It's unlikely to work on deep muscle or joint pain. But give it a try on the foot pain.
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Old 10-14-19, 06:01 PM
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Old 10-21-19, 11:10 AM
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meanwhile, you can deal with MN mechanically by increasing the space between (usual location) the 3rd and 4th toes--e.g., the strategic placement of a small roll of something like moleskin on the ball of the foot (to make room for the troubled nerve).
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Old 10-24-19, 08:08 AM
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Originally Posted by McBTC
meanwhile, you can deal with MN mechanically by increasing the space between (usual location) the 3rd and 4th toes --e.g., the strategic placement of a small roll of something like moleskin on the ball of the foot (to make room for the troubled nerve).
I tried that for a while a few years ago. Didn't really offer much relief in my case. What does work for me is actually putting a spacer between the 3rd/4th toe (phalanges) instead of on the ball of the foot. Keeping the phalanges spread apart is enough to also create a bit more space between the metatarsals which is actually where the nerve issue is located.

I actually go to the podiatrist later today for the second injection for the permanent relief. The steroids wore off over last weekend and the non-related aches and pains are back.

Dan
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Old 10-24-19, 08:11 AM
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we're living too long
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Old 10-24-19, 11:24 AM
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As an oncologist said to me once, "Dr. Google is not your friend..."
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Old 01-01-20, 07:28 AM
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Originally Posted by blacknbluebikes
As an oncologist said to me once, "Dr. Google is not your friend..."
I put my symptoms in Web MD.. and I either have leprosy, or I stubbed my toe on the end table..
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Old 01-02-20, 05:59 AM
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Originally Posted by blacknbluebikes
As an oncologist said to me once, "Dr. Google is not your friend..."
Ain't THAT the truth ^.

As someone who almost checked out from cancer I can tell you from experience, Google is the best way to get hysterical. Prior to my diagnosis I rarely went to the doctor and was "healthy as a horse". After being diagnosed, treated and surviving I couldn't watch a medical show on TV. The first six months after being given the "all clear" TV shows convinced me I had sickle cell, ovarian cancer and a brain tumor the size of a Buick.

There's a fine line between being an informed patient and making yourself crazy/impeding good medicine. I gotta give doctors their props; imagine someone coming to you for help or advice about something you know very well, worked hard to learn and then they disregard or dispute the answer based on what they read on the internet.
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Old 01-02-20, 02:23 PM
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Originally Posted by nomadmax
Ain't THAT the truth ^.

As someone who almost checked out from cancer I can tell you from experience, Google is the best way to get hysterical. Prior to my diagnosis I rarely went to the doctor and was "healthy as a horse". After being diagnosed, treated and surviving I couldn't watch a medical show on TV. The first six months after being given the "all clear" TV shows convinced me I had sickle cell, ovarian cancer and a brain tumor the size of a Buick.

There's a fine line between being an informed patient and making yourself crazy/impeding good medicine. I gotta give doctors their props; imagine someone coming to you for help or advice about something you know very well, worked hard to learn and then they disregard or dispute the answer based on what they read on the internet.
I agree with this and it needs to be said, but I will relate an anecdote which illustrates the upside of looking stuff up on the internet. I am a physician, by the way.

A sailing buddy and close friend, a very smart engineer and retired Navy carrier pilot and XO, grew himself a very bad tumor (a highly anaplastic sarcoma) in a very bad place (wrapped around the great vessels under the diaphragm). He followed the referral pathway his local medical oncologist set out and he ended up at a major academic center in DC, whose name rhymes with "Porgetown." There, the local Prince of Surgical Oncology looked at the MRI and the biopsy slides and told him the tumor was inoperable and to go home and get his affairs in order. He went home overwhelmed with grief and fear and was referred for palliative chemo. However, to pass the time waiting for the Grim Reaper to show up, he decided to see what Google and then Pubmed had to say on the matter and within an hour had found a REAL expert at Sloan Kettering, who said, "Yeah, we do a few of those a month." He sent my friend to a medical oncologist at the another academic center in DC, indeed a real sarcoma specialist, for a molecular diagnosis and six rounds of aggressive chemo to shrink the tumor, maybe kill it. After radiation, he had the surgery, then more chemo. Now, he's potentially cured and coming up on his third disease-free year. We did a Bermuda race together last summer. If he had listened to the first ******* and ignored Dr. Google, he'd be dead. Let me also say that the first surgeon should have done the damn Google job himself if he was so dumb he didn't even know who the academic leaders in his field were. God, this just pisses me off every time I tell it!

Dr. Google leaves a lot to be desired as a treating physician, but there's a surprising amount of mediocre-to-patently bad medicine out there and he's a hell of a lot better than nothing in many cases. There's nothing wrong with checking up on what your doctor tells you and challenging them on it. If they can't take a little questioning, that's not a good sign. Also, if you stick to the stuff near the top of the first page of the search, you'll avoid the most of the "woo" and anti-scientific garbage. Don't ask me how I know this.

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Old 01-02-20, 05:45 PM
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^^Ditto this.^^

Googling around for health/medical info isn't a bad thing if approached carefully and cautiously. Cross check pop culture articles against the original sources. Sometimes pop culture writers misinterpret conclusions of studies. Others with nicknames like "Avocado" and "Health Ranger" deliberately misrepresent studies or take things out of context. It's clickbait designed to drive traffic, ad revenue and to sell their snake oil.

But there is good info available. The trick is to crosscheck it against reliable sources, original studies on PubMed and similarly credible sites, and in many cases getting plain language interpretations of highly technical studies.

About 20 years ago I was diagnosed with Hashimoto's, a pesky but nonfatal auto-immune disorder. At the time we had very slow internet access so I did maybe a cursory search (pre-Google, probably Lycos or Yahoo, I don't remember) and concluded, incorrectly, that "Hashimoto's" was akin to fibromyalgia or Morgellons -- one of those self-diagnosis things that many medical professionals dismiss as attributing symptoms to made-up syndromes. So I never followed through.

Long story short, I got so busy as caregiver for my grandmother and mom that I neglected my own health for years. It finally all caught up with me in 2018. I was hit by a car, breaking and dislocating my shoulder, and in X-rays to check my neck (which was broken in 2001, when my car was t-boned by another driver who ran a light) the techs discovered my thyroid was an opaque calcified lump. Biopsies revealed cancer. Fortunately surgery got it, no metastasis or chemo.

Only *after* all this happened -- my mom's death, my own illness -- did I finally get around to researching my own symptoms. The thyroid disease explained it all. But for years other doctors, nurse practitioners and physician's assistants basically ignored and dismissed my health complaints, never did any tests or real diagnoses.

If I hadn't been so wary of pop culture health articles online, I might have dug in deeper, read some real medical studies on PubMed and similarly credible sources, and realized years ago I needed to take the original diagnosis of Hashimoto's more seriously.

Dr. Google can be your friend, if you're careful to ignore his off-topic rambling, tangents and tendency to weigh credible research and woo equally.
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Old 01-03-20, 04:37 AM
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Originally Posted by MoAlpha
I agree with this and it needs to be said, but I will relate an anecdote which illustrates the upside of looking stuff up on the internet. I am a physician, by the way.

A sailing buddy and close friend, a very smart engineer and retired Navy carrier pilot and XO, grew himself a very bad tumor (a highly anaplastic sarcoma) in a very bad place (wrapped around the great vessels under the diaphragm). He followed the referral pathway his local medical oncologist set out and he ended up at a major academic center in DC, whose name rhymes with "Porgetown." There, the local Prince of Surgical Oncology looked at the MRI and the biopsy slides and told him the tumor was inoperable and to go home and get his affairs in order. He went home overwhelmed with grief and fear and was referred for palliative chemo. However, to pass the time waiting for the Grim Reaper to show up, he decided to see what Google and then Pubmed had to say on the matter and within an hour had found a REAL expert at Sloan Kettering, who said, "Yeah, we do a few of those a month." He sent my friend to a medical oncologist at the another academic center in DC, indeed a real sarcoma specialist, for a molecular diagnosis and six rounds of aggressive chemo to shrink the tumor, maybe kill it. After radiation, he had the surgery, then more chemo. Now, he's potentially cured and coming up on his third disease-free year. We did a Bermuda race together last summer. If he had listened to the first ******* and ignored Dr. Google, he'd be dead. Let me also say that the first surgeon should have done the damn Google job himself if he was so dumb he didn't even know who the academic leaders in his field were. God, this just pisses me off every time I tell it!

Dr. Google leaves a lot to be desired as a treating physician, but there's a surprising amount of mediocre-to-patently bad medicine out there and he's a hell of a lot better than nothing in many cases. There's nothing wrong with checking up on what your doctor tells you and challenging them on it. If they can't take a little questioning, that's not a good sign. Also, if you stick to the stuff near the top of the first page of the search, you'll avoid the most of the "woo" and anti-scientific garbage. Don't ask me how I know this.
I am fortunate that my experience with cancer, despite a grim diagnosis, was a positive one. My PCP got on the ball, didn't take a "wait and see" attitude and made the discovery. He immediately referred me to an oncologist who got me in asap. Despite my desire to stay local and have him treat me (the local oncologist), he implored me to go to Ohio State, Cleveland Clinic or U of Cincinnati. I didn't want to put my family out hauling me all over the state to treat something that didn't look very positive and would end up with the same results.

During the consult/exam he asked if he could step out for a moment and do some research. He came back with printed dossiers of physicians who he thought could help me, all were from the places he mentioned. When I asked him what could they do that he couldn't, he looked at me and said "Son, there's a reason why my office is behind an Applebees and they are where they are". The he pointed to a surgeon/oncology team at the James Cancer Center at Ohio State (the surgeon had come from Sloan Kettering and the oncologist from Cleveland Clinic). His office arranged an appointment the next day and they saved my life.

I know there's great, good, medium and bad in every profession, but for a guy to be humble enough to say "I'm not that good, let's see where you need to go" says volumes about their character and why they became a physician in the first place. Based on that one time in my life I guess my view of the medical profession is tilted toward the more physicians are good/knowledgeable than are not. I can tell you this, those four guys get a Christmas e-mail from me every year with photos of all the things I got to do and thanking them for another year I didn't have.

OP, I hope you get yourself someone you can 100% trust and get you sorted out. There's no better feeling than having someone like that on the job when you're having trouble and/or are scared to death.

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Old 01-05-20, 10:31 AM
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If I ever google a condition, it's to decide if I should treat it seriously or not. I have any number of chronic issues, but I usually refuse to take steroids for them. I am pretty sure that steroids would make some of them worse. I had one podiatrist that really wanted to give me cortisone shots for my Morton's neuroma, but it has been well controlled with just orthotics.

If you have any predisposition, prednesone can make you manic. It can be very ugly, I have seen it up close.
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Old 01-05-20, 05:57 PM
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Originally Posted by unterhausen
If you have any predisposition, prednesone can make you manic. It can be very ugly, I have seen it up close.
AKA "'roid rage." You don't even need to have a predisposition, although that may make it more likely to occur. My father was a very gentle man, but developed lupus toward the end of his life and was placed on prednisone. He developed an irrational hatred for his dentist, whom he had known and gotten along with fine for decades. He had to switch dentists as a result.
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